Prevalence of cognitive impairment and change in patients with breast cancer: A systematic review of longitudinal studies

Abstract

Objective: Patients with breast cancer face cognitive impairment that affects their quality of life; partially attributable to treatment. Our aim was to detail the prevalence and change of cognitive impairment during the course of treatment. We also investigated the effect of therapy (chemotherapy [CT]) vs. radiotherapy and/or endocrine therapy vs. healthy controls).

Methods: This article reviews longitudinal cohort studies published to date in Medline and Embase that (i) assess cognition before and after therapy, (ii) report prevalence cognitive impairment or change, and (iii) use standardized and valid neuropsychological tests. We used the original authors' criteria for cognitive impairment.

Results: The title and abstract of 891 articles were screened, resulting in the identification of 90 potentially relevant articles while applying the eligibility criteria. After full-text examination, 17 studies were included. Prevalence of cognitive impairment range from 25% before therapy, through 24% after therapy to 21% at maximal 1-year follow-up (FU). Compared to their pretreatment cognitive functioning, 24% of patients decline after treatment and 24% at 1-year FU. Some studies also reported cognitive improvement showing that 15% and 31% of patients improve, respectively. In general, patients undergoing CT have a higher chance of cognitive impairment and decline than no-CT patients and healthy controls.

Conclusions: This study shows that one out of four breast cancer patients shows cognitive impairment prior to treatment administration CT and a significant number of patients decline during the course of disease, suggesting that cognitive impairment is not exclusively related to CT and/or no-CT therapies. This study shows that assessment of cognitive functioning, ideally over time, is crucial and may help the implementation of personalized rehabilitation pathways.

Keywords: cancer; cancer-related cognitive impairment; chemotherapy-related cognitive impairment; longitudinal studies; mamma carcinoma; oncology.

FIGURE 1

Timeline of the breast cancer treatment stages and the cross‐sectional and longitudinal time points of data assessment. The “CT‐group” consists of patients indicated for chemotherapy and if necessary, radiotherapy and/or endocrine therapy. The “no‐CT group” consists of patients indicated for radiotherapy and/or endocrine therapy. CT, chemotherapy; ET, endocrine therapy; FU, follow up; N, number of patients; RT, radiotherapy

FIGURE 2

Assessment of risk of the risk of bias across studies

FIGURE 3

PRISMA (2009) flowchart of study selection